Pre-authorizations hold up care: AMA

Health insurer pre-authorization requirements can delay or interrupt care, take up significant amounts of time and complicate medical decisions, according to the results of an American Medical Association survey released today.

Of the approximately 2,400 physicians participating in the online survey conducted in May, 37% said they experienced a 20% rejection rate on first-time pre-authorization requests for tests and procedures, and 57% said they had a similar rejection rate on pre-authorization requests for drugs.

Illustrating how pre-authorization can delay care, 63% of the surveyed doctors reported typically having to wait several days for insurer pre-authorization of a test or procedure with 13% saying they usually have to wait more than a week. Also 69% said they usually wait several days for drug pre-authorization while 10% report having to wait more than a week. In all, physicians report spending 20 hours a week on pre-authorization issues, according to the AMA.

An automated pre-authorization process would be more efficient, said 75% of the survey participants, as 52% said they appeal 80% or more of first-time pre-authorization rejections for tests and procedures and 39% said the same of rejected first-time pre-authorization requests for drugs.